Individual
LETICIA CORRIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1669 E 112TH ST, LOS ANGELES, CA 90059-1947
(323) 691-0151
Mailing address
1669 E 112TH ST, LOS ANGELES, CA 90059-1947
(323) 691-0151
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
78895
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78895
—
CA
Enumeration date
08/23/2016
Last updated
08/23/2016
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